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Knee Pain and Bicycling
- Jeffrey Booker
- 3 years ago
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1 Knee Pain and Bicycling Fitting Concepts for Clinicians CPT Chad Asplund, MD; COL Patrick St Pierre, MD THE PHYSICIAN AND SPORTSMEDICINE - VOL 32 - NO. 4 - APRIL 2004 In Brief: Anterior knee pain and patellofemoral pain syndrome are among the most common leg overuse injuries in cyclists. Bicycle fit, recent change in equipment, training distance and intensity, and individual anatomic factors are important evaluation considerations. Clinicians need a basic understanding of bicycle fitting and how anatomic factors and training errors contribute to repetitive stress injuries. After problems are addressed, a gradual return to activity is recommended to avoid further injury and improve performance. With Lance Armstrong's successes in the Tour de France and the increasing popularity of mountain biking, participation in bicycling has steadily increased over the past 10 years. Cycling is an excellent alternative for runners and other athletes seeking low-impact exercise. The Bureau of Transportation Statistics at the US Department of Transportation estimates that more than 49 million Americans ride bicycles at least monthly, with over 5 million people riding at least 20 days per month. 1 The number of cycling-related injuries has also risen, with the majority caused by overuse. Injuries may also be related to improper bicycle fit or equipment, poor technique, or inappropriate training patterns. Cycling is very repetitive; during 1 hour of cycling, a rider may average up to 5,000 pedal revolutions. The smallest amount of malalignment, whether anatomic or equipment related, can lead to dysfunction, impaired performance, and pain. Several studies in athletes 2-5 have demonstrated that knee injuries, including anterior knee pain and patellofemoral pain syndrome, are the most common overuse injuries evaluated in sports medicine centers. Overuse injuries occur when a tissue accumulates damage caused by repetitive submaximal loading. Repetitive activity fatigues a specific structure, such as tendon or bone. Without adequate recovery, microtrauma stimulates an inflammatory response, causing the release of vasoactive substances, inflammatory cells, and enzymes that damage local tissue. Cumulative microtrauma from further repetitive activity eventually leads to clinical injury. In chronic cases, continued activity produces degenerative changes that lead to weakness, loss of flexibility, and chronic pain. Thus, in overuse injuries, the problem is often not acute tissue inflammation, but chronic degeneration or tendinosis instead of tendinitis. 6 Pain in overuse injuries typically has insidious onset, but it may have an acute-on-chronic presentation. Overuse injuries most likely occur when an athlete changes the mode, intensity, or duration of training. Biomechanic (intrinsic) factors and equipment or training (extrinsic) issues are the main contributors to overuse injuries. Training errors are leading causes of overuse knee injuries. Holmes et al 7 showed that heavy training loads and high mileage contribute substantially to knee injuries. Likewise, a rapid increase in training distance or intensity, seen in the early cycling season, also leads to overuse injuries. Knee pain is the most common lower-extremity overuse problem in cyclists. 7,8 In one recreational long-distance bicycling tour, 65% of all riders reported knee pain. 9 Another study 10 of more than 500 recreational cyclists indicated that almost 42% of all riders experienced overuse knee pain. While major problems such as fractures, dislocations, and ligament ruptures usually occur only after major trauma, overuse injuries are much more common.
2 When evaluating knee pain and cycling-related overuse injuries, important considerations include bicycle fit, training distance and intensity, and anatomic factors such as leg-length discrepancy, muscle imbalance, and inflexibility (table 1). 7,8,11 TABLE 1. Causes of Knee Pain in Bicycling Factor Anatomy Leg-length discrepancy Wide pelvis Pes planus and/or pronation Internal tibial rotation Muscle weakness of quadriceps, hamstrings, hip flexors, gluteus Leg inflexibility Bike Fit Saddle too high Saddle too low Saddle too far forward Saddle too far back Crank arms too long Internally rotated cleats Externally rotated cleats Training Rapid increase in distance or intensity Excessive hill work (on bike) Pushing high gear ratio Hill running (on foot) Deep leg squats Possible Result ITB stretch on shorter leg, posterior knee stress Lateral knee stress (increased Q angle) Medial knee pain Patellar malalignment Fatigue-induced alterations in pedaling technique that transfer stress to other parts of the kinetic chain ITB syndrome Knee extension that irritates the ITB, stress on biceps tendon, patellofemoral loading, hips stressed by rocking while pedaling, posterior knee pain Stress on patellar and quadriceps tendons Stress on anterior knee from pedaling in hyperflexed position ITB stretch from excessive forward reach for pedal, stress on biceps tendon Increased forces on the entire knee; patellar tendon and quadriceps tendon are most affected Patellar tendinosis, tibial rotation stress on anterior knee Medial knee stress Muscle tightness, microtrauma Cartilaginous breakdown, chondromalacia Medial knee stress Medial knee stress (uphill), tight quadriceps (downhill) Increased stress on entire knee ITB = iliotibial band Bicycle Anatomy Bicycles consist of a frame, handlebars, brakes, wheels, pedals, gears, and other components (figure 1). The key part is the frame, made of metal or metal alloys such as titanium, aluminum, steel, or carbon. Frames can be thought of as two triangles. The front triangle consists of the top tube, the seat tube, and the down tube. The chainstay, seatstay, and seat tube compose the rear triangle. Handling and maneuverability can be affected by the angles within each of these triangles. Racing bicycles have a more upright geometry,
3 with steeper angles for increased maneuverability. Touring bicycles are more stable, with a flatter geometry for comfort. Frame size is determined by the seat tube dimension in centimeters, measured from the center of the bottom bracket to the center of the top tube or from the top of the bottom bracket to the top of the top tube. The top tube length affects the reach of the rider and is also an important measurement for proper frame fit. The crank arm, chain ring, chain, gears, and derailleurs make up the drive train and transfer human energy to mechanical energy. The pedal stroke can be thought of as a continuous circular movement, with the ultimate goal of spinning the pedals in a smooth, circular motion. Gearing is a method of overcoming resistance that allows the cyclist to pedal comfortably at a uniform cadence to improve pedaling efficiency. Higher gears result in higher resistance, and lower gearing provides less resistance. The shoe-pedal interface is vital to energy transfer. Stiff-soled cycling shoes clip directly into the pedals, linking the rider directly to the bicycle. Bicycling Biomechanics One complete circular movement of the pedals around the bottom bracket is one twophase pedal cycle. In the power phase, the cyclist pushes down on the pedal and transfers the greatest amount of energy to move the bicycle forward. The power phase begins with the pedal in the 12-o'clock position and ends with the pedal at the 6-o'clock position. The power phase is followed by the recovery phase, which progresses from 6-o'clock back to the 12-o'clock position. During the pedal cycle, the knee goes through approximately 75 of motion. The knee begins the power phase flexed about 110 and extends to about 35 of flexion. The quadriceps muscle provides most of the force, with input from the hamstring and gluteal muscles. While the knee extends, it also adducts because of the normal valgus angulation of the distal femoral condyles relative to the femoral shaft and foot motion during the power phase. This motion leads to medial translation of the knee during the pedal stroke while the knee extends. Additionally, the foot pronates during the power phase, causing an internal rotation of the tibia that increases stress on the medial knee. Also, an increased Q angle, seen in females, may further stress the medial joint. During the recovery phase of the pedal stroke, the knee flexes and moves laterally while the tibia externally rotates to ready the leg for the power phase of the next pedal cycle. Biomechanic abnormalities may arise from anatomic as well as functional factors. Muscular inflexibility is a leading contributor to injury. Most cyclists' quadriceps and hamstrings will tighten with prolonged riding. Inflexibility of the quadriceps, hamstrings, or iliotibial band (ITB) may restrict range of motion around the knee and are likely to increase the forces on the knee. 6 Weakness in the leg muscles may lead to fatigue-induced alterations in pedaling technique, which will also alter the forces on the knee. Inappropriate saddle height or improperly aligned shoe cleats transmit increased repetitive forces through the knee, with a greater likelihood of injury. 12 Anterior Knee Pain Patients frequently report anterior knee pain that may be related to repetitive stress or to inflammation. In fact, anterior knee pain is the most common reason bicyclists seek
4 physician care. 13 Causes of anterior knee pain include patellofemoral pain syndrome, chondromalacia, quadriceps tendinosis, patellar tendinosis, and, occasionally, prepatellar bursitis. Patellofemoral pain syndrome, also called retropatellar pain syndrome, refers to anterior knee pain emanating from the patellofemoral joint and supporting soft tissues. Patellofemoral pain syndrome is an early indication of cartilage softening that can progress to frank cartilaginous damage (chondromalacia). Patellofemoral pain syndrome is typically an office diagnosis, while chondromalacia is a surgical or radiologic diagnosis. Because both usually arise from collagen breakdown rather than frank inflammation, they are currently seen as tendinosis rather than tendinitis. 6 Patellofemoral pain syndrome is related to a combination of factors involving malalignment of the knee extensor mechanism. 14,15 Patients generally report that anterior knee pain is worse when the knee is loaded (eg, when climbing or descending stairs, during prolonged sitting or squatting). Patellofemoral joint problems frequently differ between cyclists and runners--many cyclists will point to the center of their patella and describe the pain as being directly under the patella, rather than on the medial or lateral side. 12 The pain, sometimes severe, often occurs after cycling, rather than during the ride. Chondromalacia, characterized by pain or crepitation in the retropatellar area, is described as a grating sensation with anterior patellofemoral discomfort that worsens with climbing, squatting, or prolonged sitting. The condition may be caused by articular cartilage breakdown or chronic synovial inflammation. Excessive patellar shear forces over the femoral condyles and patellar groove with malalignment of the patella contribute to cartilaginous breakdown. Cyclists who have pes planus, overpronation of the foot, or hindfoot valgum may also have a greater degree of patellar malalignment. During cycling, the pain is precipitated by riding up hills or when the rider pushes higher gears with a slow pedal cadence. Quadriceps tendinosis is characterized by pain at the quadriceps tendon's insertion into the patella. The pain may be located medially or laterally to the suprapatellar area but is more commonly seen on the lateral side in cyclists. Tendinosis may follow an acute traumatic event but is usually caused by repetitive stress, with poor bike fit as a common contributing factor. Patellar tendinosis can result from irritation of the patellar tendon and is most likely caused by excess angular traction on the tendon when the rider pedals with improperly positioned cleats. 7 Cyclists usually report significant patellar tendon pain related to pedaling and other knee-extension activities. Focal swelling around the patellar tendon with palpable crepitus may be seen. Prepatellar bursitis, less common in cycling, should be suspected when swelling and tenderness anterior to the patella exist and can arise from acute trauma. Chronic prepatellar bursitis is more common than the acute form and usually results from repeated microtrauma, such as bicycle pedaling. Careful Inspection When evaluating a cyclist who has anterior knee pain, inspect the bicycle fit. The saddle may be too low, too far forward, or both, causing excessive patellofemoral loading throughout the pedal cycle. When the saddle is low, the knee functions in hyperflexion, increasing compression of the patella on the femur.
5 Improper shoe cleat position or float may force the rider to pedal with poor biomechanics, increasing patellar forces. Float is the motion of the cleat on the body of the pedal and is usually measured in degrees of internal or external angulation (ie, 9 of float means that the foot may rotate 9 inward or outward relative to the pedal body). Cleats with excessive internal or external rotation may cause exaggerated tibial rotation, placing more stress on the anterior knee. Medial Knee Pain The normal pedaling motion causes the tibia to internally rotate when the knee is extended. Medial knee pain results when increased stress from improper saddle height, saddle fore-and-aft position, or cleat position (toes pointed too far outward) increases internal tibial rotation. Poor leg flexibility and training errors, such as riding in gears that are too high or excessive hill climbing, increase stress and exacerbate medial knee conditions. Anatomic abnormalities, such as genu varus, overpronation, inherent tibial rotation, and hamstring tightness, may also exacerbate medial knee pain. Medial knee pain often is caused by pes anserine bursitis or mediopatellar plica syndrome. Pes anserine bursitis is identified by insidious-onset pain over the medial proximal tibial metaphysis approximately 2 to 4 cm below the joint line. 16 Direct trauma or repeated friction over the bursa can lead to inflammation. When the bursa is inflamed, contraction of the hamstring muscles, tibial rotation, and direct pressure over the pes anserine bursa usually produce pain. The popliteal angle should be measured and tightness treated with hamstring-stretching exercises. Mediopatellar plica syndrome causes pain over the medial retinaculum. A plica is a synovial septum remnant from the embryologic knee. Medial plica occurs in up to 30% of the population. 17 Medial plica may impinge on the femoral condyle during knee flexion, leading to inflammation and swelling. If a normal medial plica is chronically inflamed and turns fibrotic, it may bow-string over the medial femoral condyle during knee flexion and cause irritation and a snapping sensation. The cyclist who has plica symptoms may describe a disabling medial knee pain accompanied by a sensation of medial popping that occurs with each pedaling stroke. Treatment for a symptomatic plica involves adjusting the saddle fit and cleat position to reduce forces on the anterior knee. A local anesthetic may be injected directly into the plica to give temporary relief. Orthopedic referral should be made if symptoms persist longer than 6 months. Lateral Knee Pain Anatomic factors and improper bike fit are important considerations when evaluating cyclists who report lateral knee pain. Iliotibial band syndrome. The ITB is a thick, fibrous band that runs on the outside of the leg from the hip to the knee. ITB syndrome is caused by inflammation of the intraarticular synovium or ITB fascia when the tight ITB repeatedly rubs over the lateral condyle as it moves posteriorly with flexion and anteriorly with extension. Tight, inflexible leg muscles may worsen the condition. Cyclists who have ITB syndrome experience sharp or stabbing lateral knee pain and may report decreased pedaling power because of pain. The most obvious sources of ITB irritation are anatomic abnormalities and improper bicycle fit. Excess internal tibial rotation, either anatomic or caused by improper cleat position, places significant stress on the distal ITB as it crosses the lateral femoral
6 epicondyle. Varus knee alignment or excess pronation will increase the stretch on the ITB. Similarly, leg-length discrepancies cause difficulty, because only one leg is correctly fitted to the pedal, producing excessive ITB stretch on the shorter leg. Saddle position can also be a contributing factor. A saddle that is too high results in knee extension greater than 150 that can irritate the distal ITB. Saddles that are too far back cause excessive forward reach for the pedal, also stretching the ITB. Posterior Knee Pain Posterior knee complaints in cycling are rare. Most often they are attributed to biceps tendinosis or, less frequently, medial hamstring tendinosis. Cyclists who have biceps tendinosis report insidious onset of point tenderness at the tendinous attachment of the biceps femoris where it inserts on the fibular head. 7 Saddles that are too high or too far back can stress the biceps tendon. Excessive internal rotation of the cleats will also increase stress. Varus alignment of the knees or leg-length discrepancies may also contribute to posterior knee pain. If the saddle height is set for the longer leg, the shorter leg will be forced to stretch farther with each pedal stroke, increasing posterior knee stress. Addressing Pain Initial management following an overuse injury should follow the PRICEMM acronym (protection, rest, ice, compression, elevation, modalities, and medications) 5 to help control inflammation and allow the tissue to heal. Decreasing inflammation and pain helps increase range of motion, allows early rehabilitation, and speeds return to competition. Once healing and rehabilitative exercise have restored damaged tissues to normal strength, patients will need further training to achieve the supernormal endurance and power required for the demands of sports. With tendinosis, relative tendon unloading is critical for treatment success. 6 Unloading may be accomplished by correcting anatomic, functional, or equipment related errors. Bicycle adjustment. Most bicycle shops will evaluate and adjust bike fit for the primary rider at a reasonable cost. The quality of bike fits can be quite variable, and local bike clubs should be able to provide references. A simple saddle height adjustment may ease the forces placed on the knee. If the saddle is too low, too much stress is placed on the knee from the patellar and quadriceps tendons. If the saddle is too high, pain may develop behind the knee. Proper saddle height can be determined in several different ways. The easiest way is to allow one pedal to drop to the 6-o'clock position and observe the angle of flexion in the knee joint. There should be a 25 to 30 flexion in the knee when the pedal is at the bottom-most point. 7 Another method is to measure the inseam (in cm) and multiply by to get the correct distance from the top of the saddle to the center of the bottom bracket. 18 If the hips rock back and forth when pedaling, the saddle is too high; lower the saddle until a smooth pedal stroke is achieved. Saddle fore-and-aft positions and shoe cleat position may also contribute to knee pain. Saddles that are too far back cause the cyclist to reach for the pedal and stretch the ITB, resulting in knee pain. Saddles that are too far forward will force pedaling in a hyperflexed position, increasing the force on the anterior knee. Saddle position can be
7 evaluated with the plumb bob technique. Seated with the pedal in the 3-o'clock position, a plumb hung from the most anterior portion of the knee should intersect the ball of the foot and the axle of the pedal. Cleats that are internally rotated too far may increase stress on the ITB as it crosses the outside of the knee. Excessive external rotation will cause medial knee stress. Cleats should be positioned fore or aft so that the ball of the foot is directly over the axle of the pedal. Rotational cleat position can be evaluated with a bike shop "fit kit" or rotational adjustment device--this is more important for cleats with less than 5 of float. Most new road cleats allow greater degrees of float to protect the knees. Correcting anatomic problems. Individual cyclist anatomy may contribute to knee and hip pain. Cyclists with leg-length discrepancies may develop knee pain, because only one side is correctly fitted to the bicycle. Cyclists with flat feet may be more prone to excessive pronation (internal rotation) of the leg, causing greater stress on the ITB at the knee, as well as on the medial knee. Customized orthoses may correct the alignment of the knee and decrease or prevent medial or lateral rotational stress on the connective tissue in the ankle, knee, or hip, thus reducing pain. Orthoses may influence the pattern of leg movement through a combination of mechanical control and biofeedback 19 or the clinical functions of motion control, pressure relief, and redistribution of forces. 20 Cyclists require a different type of orthoses than runners; cycling orthoses are longer and provide additional metatarsal support. Pedal shims or shoe lifts may help correct malalignment or leg-length discrepancies. Return After Injury The first guideline during a rebuilding period is to start slowly. In the early stages of a comeback, cyclists should do a condensed version of their normal training schedule, progressing only when easy rides are pain-free (table 2). During this transition, the athlete should use lower resistance and higher cadence to allow a gradual return to activity. A good rule is that for every week of cycling-specific training missed, allow 1 to 2 weeks of training to return to previous form. 21,22 TABLE 2. Recommended Program for Return to Cycling After Injury Length of Rehabilitation Multiply the duration of the layoff (in weeks) by 1 (for less severe injuries) or 2 (for more severe injuries) to estimate how many weeks it will take to return to preinjury training level. Example: Layoff for a more severe injury (2 wk missed) X 2 = 4 wk of reduced training Stages for a 4- to 6-Wk Rehabilitation Stage 1 (1-2 wk): Easy rides without fatigue or pain Stage 2 (1-2 wk): Endurance pace work at 50% to 75% of effort and distance of preinjury workouts Stage 3 (1 wk): Moderate-intensity work until the cyclist can complete full preinjury distance
8 Stage 4 (1 wk): High-intensity work at full preinjury distance Stage 5: Return to full competition Note: Cyclists may advance to the next stage when they can perform the current stage on 2 consecutive days without pain. Preventing Overuse Injuries The preparticipation physical exam is an excellent opportunity to ask about and address previous overuse injuries. The cyclist should be counseled about increasing activity using the "10% rule"--increasing distance and intensity by 10% each week during early- season and build-up periods. 23 Athletes who have a history of overuse injuries should be examined for weakness and flexibility deficits and may benefit from early-season stretching and strengthening programs. 5 A pre- and postworkout stretching routine is important for continuous pain-free riding. Weakness of the quadriceps, hamstrings, or hip flexors may be assessed by manually testing resisted extension of the knee, flexion of the knee, and flexion of the hip, respectively. More accurate, quantifiable results can be obtained by performing mechanical isokinetic testing with a commercial machine such as the Biodex System 3 (Biodex Medical Systems, Inc, Shirley, New York). Flexibility of the quadriceps may be assessed by performing Ely's test and comparing the amount of passive knee flexion in each leg. Hamstring flexibility can be evaluated using the popliteal angle or the sit-andreach test. Hip flexors can be evaluated with the Thomas test, and flexibility of the ITB may be tested with the Ober test. 24 Progressive strengthening exercises are warranted for patients who have muscle weakness. 6 Initial activities include isometric quadriceps and hamstring exercises, such as quad sets and hamstring sets. Isotonic exercises such as straight-leg extension and flexion are the next phase in strengthening. Finally, patients perform eccentrically resisted knee flexion and extension with weights. 25 Flexibility focusing on the quadriceps, hamstrings, hip flexors, and ITB is important and should be a regular part of a cyclist's training regimen. As more people seek low-impact ways to improve and maintain their cardiovascular fitness, physicians will no doubt see more patients who have knee pain related to bicycling. By learning a few simple bike fitting techniques, physicians can treat and prevent many common problems of this popular activity. The opinions or assertions presented here are the private views of the author and are not to be construed as official or as reflecting the views of the US Department of the Army or Department of Defense. References 1. US Department of Transportation: Bureau of Transportation Statistics: Bicycle use among adult US residents. OmniStats 2002;2(6): Baquie P, Brukner P: Injuries presenting to an Australian sports medicine centre: a 12-month study. Clin J Sport Med 1997;7(1): Brody DM: Running injuries. Clin Symp 1980;32(4): Macintyre JG, Lloyd-Smith DR: Overuse running injuries, in Renström PA (ed):
9 Sports Injuries: Basic Principles of Prevention and Care. Boston, Blackwell Scientific Publications, 1993, pp O'Connor FG, Howard TM, Fieseler CM, et al: Managing overuse injuries: a systematic approach. Phys Sportsmed 1997;25(5): Cook JL, Khan KM, Maffulli N, et al: Overuse tendinosis, not tendinitis. Phys Sportsmed 2000;28(6): Holmes JC, Pruitt AL, Whalen NJ: Lower extremity overuse in bicycling. Clin Sports Med 1994;13(1): Conti-Wyneken AR: Bicycling injuries. Phys Med Rehabil Clin N Am 1999;10(1): Dannenberg AL, Needle S, Mullady D, et al: Predictors of injury among 1638 riders in a recreational long-distance bicycle tour: Cycle Across Maryland. Am J Sports Med 1996;24(6): Wilber CA, Holland GJ, Madison RE, et al: An epidemiological analysis of overuse injuries among recreational cyclists. Int J Sports Med 1995;16(3): Brown G: Injury prevention and management, in Jeukendrup AE (ed): High Performance Cycling. Champaign, IL, Human Kinetics, 2002, pp Sanner WH, O'Halloran WD: The biomechanics, etiology, and treatment of cycling injuries. J Am Podiatr Med Assoc 2000;90(7): Gregor RJ, Wheeler JB: Biomechanical factors associated with shoe/pedal interfaces: implications for injury. Sports Med 1994;17(2): Mellion MB: Bicycling, in Mellion MB (ed): Team Physician's Handbook. Philadelphia, Hanley & Belfus, 2002, pp Fredericson M: Patellofemoral pain syndrome, in O'Connor FG, Wilder RP, Nirschl R (eds): Textbook of Running Medicine. New York City, McGraw-Hill, 2001, pp Kruse RW: Evaluation of knee injuries, in Lillegard WA, Butcher JD, Rucker KS (eds): Handbook of Sports Medicine: A Symptom-Oriented Approach, ed 2. Boston, Butterworth-Heinemann, 1999, pp Theut PC, Fulkerson JP: Anterior knee pain and patellar subluxation in the adult, in DeLee JC, Drez D (eds), Orthopaedic Sports Medicine, ed 2, vol 2. Philadelphia, Saunders, 2003, p Lemond G, Gordis K: Greg LeMond's Complete Book of Bicycling. New York City, Perigee Books, 1990, pp Nawoczenski DA, Saltzman CL, Cook TM: The effect of foot structure on the three-dimensional kinematic coupling behavior of the leg and rear foot. Phys Ther 1998;78(4): Subotnick SI: Foot orthotics, in O'Connor FG, Wilder RP, Nirschl R (eds): Textbook of Running Medicine. New York City, McGraw-Hill, 2001, pp Wenzel K: Back from zero: when returning from injury, take it slow. Velo News 2003;32(10): Moore JH, Ernst GP: Therapeutic exercise, in O'Connor FG, Wilder RP, Nirschl R (eds): Textbook of Running Medicine. New York City, McGraw-Hill, 2001, pp O'Neill DB, Micheli LJ: Overuse injuries in the young athlete. Clin Sports Med 1988;7(3): Magee DJ: Orthopedic Physical Assessment. Philadelphia, WB Saunders, 1997, pp Shelbourne KD, Rask BP, Hunt S: Knee injuries, in Schenck RC (ed): Athletic Training and Sports Medicine, ed 3. Rosemont, IL, American Academy of Orthopaedic Surgeons, 1999, pp
10 Dr Asplund is a family practice physician in the department of family practice at Dewitt Army Community Hospital in Fort Belvoir, Virginia. Dr St Pierre is an assistant professor of surgery at the Uniformed Services University of Health Sciences in Bethesda, Maryland, and associate director at Nirschl Orthopaedic and Sports Medicine in Arlington, Virginia. Address correspondence to CPT Chad Asplund, MD, 5663 Marshall Rd, Fort Belvoir, VA 22060; to
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text:
Linear Theory of Thin Ringsby Harry E. Williams, Prof. of Engrg.; Harvey Mudd Coll., Claremont, CA,
Serial Information: Journal of the Engineering Mechanics Division, 1972, Vol. 98, Issue 5, Pg. 1031-1051
Document Type: Journal Paper
The equations governing small, elastostatic displacements of circular rings of arbitrary cross section are derived using the principle of virtual work. The equations are shown to be interpretable as the classical equations of equilibrium and the stress resultant-displacement equations. Of particular significant is the natural occurrence of the warping moment and its relation to the twisting moment. A method of solution is proposed in which the displacements of arbitrarily loaded ring segments are obtained in Fourier series using the method of Lagrange multipliers to account for the boundary conditions.
Subject Headings: Linear functions | Displacement (mechanics) | Arbitration | Equilibrium | Warpage | Load factors | Fourier analysis | Lagrangian functions
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Sandoz gets FDA nod for Altavera
PRINCETON, N.J. — The Food and Drug Administration has approved an oral contraceptive made by Sandoz, the company said Friday.
Sandoz, the generics division of Swiss drug maker Novartis, announced the approval of Altavera (levonorgestrel and ethinyl estradiol) tablets, a generic version of Duramed's Nordette.
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"Winn-Dixie is making it easy for our customers to dispose of unwanted medications, preventing potential misuse of these medications and also preventing contamination of our lakes and rivers, many of which serve as community water supplies," stated John Fegan, Winn-Dixie VP pharmacy.
Customers can place unwanted prescription and over-the-counter medications, excluding controlled drugs, in the envelope, seal it and then drop it in the mail. The postage-paid envelope is sent to an approved treatment facility, where licensed law enforcement oversees the safe and environmentally responsible disposal process.
The TakeAway envelope solutions are available for $2.99 in all of Winn-Dixie's 379 in-store pharmacies in Florida, Alabama, Georgia, Louisiana and Mississippi.
Controlled medications are excluded from this program because of current federal regulations.
Endo to acquire American Medical Systems
CHADDS FORD, Pa. — Endo Pharmaceuticals will buy American Medical Systems for $2.9 billion, the drug maker said Monday.
Endo said it and AMS had reached an agreement whereby Endo would acquire the maker of devices and therapies for pelvic health for $30 per share. AMS' business focuses on men's health, women's health and benign prostatic hyperplasia.
"This acquisition is a great step in achieving Endo's core strategy," Endo president and CEO Dave Holveck said. "We are creating a company uniquely positioned to respond to the changing healthcare environment and the competitive, rapidly consolidating industry landscape. Through the acquisition of AMS, we will gain scale in devices and services and will be positioned as a leading provider of healthcare solutions in the field of pelvic health, with a full spectrum of product offerings ranging from pharmaceuticals to medical devices."


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50 U.S. Code § 2121 - Voluntary contributions
Under such regulations as may be prescribed by the Director, a participant may voluntarily contribute additional sums in multiples of one percent of the participant's basic pay, but not in excess of 10 percent of such basic pay.
The benefits provided by subsection (b)(2), (3), or (4) shall be actuarially equivalent in value to the payment provided for in subsection (b)(1) and shall be calculated upon such tables of mortality as may be from time to time prescribed for this purpose by the Director.
A voluntary contribution account shall be paid in a lump sum at such time as the participant dies or separates from the Agency without entitlement to an annuity. In the case of death, the account shall be paid in the order of precedence specified in section 2071(c) of this title.
Any benefit payable to a participant or to the participant's beneficiary with respect to the additional contributions provided under this section shall be in addition to benefits otherwise provided under this subchapter.
A prior section 281 of Pub. L. 88–643, title II, Oct. 13, 1964, 78 Stat. 1053; Ex. Ord. No. 12443, § 3, Sept. 27, 1983, 48 F.R. 44751; Pub. L. 99–335, title V, § 501(2), June 6, 1986, 100 Stat. 622, related to voluntary contributions and was set out as a note under section 403 of this title prior to the general amendment of Pub. L. 88–643 by section 802 of Pub. L. 102–496.
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The Instigator
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The Contender
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Is Ebonics a Real Language
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2nd: The definition for the word language, according to the dictionary, is: a body of words and the systems for their use common to a people who are of the same community or nation.
As you have just stated, and as everyone knows, Ebonics is most commonly used with African American/Black people. So in keeping with what the dictionary says, because Ebonics is most commonly used by the people of the African American/Black community, it is in fact a language.
a variety of a language that is distinguished from other varieties of the same language by features of phonology, grammar, and vocabulary, and by its use by a group of speakers who are set off from others geographically or socially.
According to this definition, Ebonics can be considered a dialect of the English language. Ebonics, similar to English in the use of vocabulary and grammar, is as you stated mainly used by the "African-American/Black culture", and it is fair to say that this culture is separated socially from other cultures, and if we can take that social aspect one step further, Ebonics is spoken among the middle to lower class African-american/black community as common knowledge would show. thus proving two social factors that separate those who "speak" Ebonics, and those who speak English and fulfilling the definition of a dialect rather than a language
Also, Ebonics could not be a language because many linguistics know, a language is more political and cultural than just a group of words with grammar rules. For example you can take the Chinese and the Japanese. Though to an outside spectator that knows little of the two, the languages may sound, and actually be similar, but weather they are, or not is irrelevant. If you tell a Chinese person that he speaks Japanese he/she would most likely correct you because telling them that they speak Japanese can be considered an insult, culturally and politically that person is Chinese and not Japanese, thus it is reflected in there language.
Japan and China are politically, and literally separated, thus represented in there language. However those who 'speak' Ebonics, doubtfully, would like to be separated from their counter-parts who speak English. Yes there among those two groups (Ebonics 'speakers', and English speakers) but this separation is not political or cultural.
This separation can not be considered a cultural separation because I do not believe that all African-Americans/Blacks would like to be culturally linked to being able to 'speak Ebonics, however all Chinese (as those who are of direct Chinese decent and live in china) are culturally associated with the Chinese language.
2nd: It may be true that Ebonics borrows heavily from the English language, but doesn't English do the same thing? English after all is based on both Greek and Italian. But English isn't a dialect. It is a language. Just like English has its own rules and punctuation, Ebonics does too. That implies that Ebonics has the qualities of a language and therefore it is a language.
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Street View is the best available vantage point looking, if possible, towards the location of the building. In some locations, Street View may not give a view of the actual building, or may not be available at all. Where it is not available, the satellite view is shown instead.
Latitude: 51.4281 / 51°25'41"N
Longitude: -1.6638 / 1°39'49"W
OS Eastings: 423469
OS Northings: 169955
OS Grid: SU234699
Mapcode National: GBR 5YH.D5L
Mapcode Global: VHC1Q.3CRK
Entry Name: Granary 20 Metres South South West of West Corner of Church Farmhouse
Listing Date: 6 March 1985
Grade: II
Source: Historic England
Source ID: 1034105
English Heritage Legacy ID: 310693
Location: Ramsbury, Wiltshire, SN8
County: Wiltshire
Civil Parish: Ramsbury
Traditional County: Wiltshire
Lieutenancy Area (Ceremonial County): Wiltshire
SU 26 NW RAMSBURY STONE LANE, Axford
6/177 Granary 20m south-south-west
of west corner of Church Farmhouse
Granary, C18. Timber framed with brick noggings mounted on
staddles and some brick piers. Gable weatherboarded and slate
roof. 2 x 3 bays. Boarded door in east gable. Roof half-hipped.
Granaries with exposed framing are uncommon in the area.
Listing NGR: SU2346969955
This text is from the original listing, and may not necessarily reflect the current setting of the building.
Other nearby listed buildings


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Spanish: Accelerated I and II
If you have previously studied Spanish and want to review the basics, or if you have a strong knowledge of a cognate language, then this course is the appropriate next step in your Spanish-language study. This fast-paced course condenses the material covered in two levels into the time it normally takes to complete one. The instructional methodology employed is geared toward enhancing both oral and written proficiency. By the end of this course, reach the intermediate-low level on the ACTFL proficiency scale.
You'll Walk Away with
- Greater written and spoken skills in Spanish
- Intermediate-level Spanish proficiency
Ideal for
- Students with previous exposure to Spanish
- Fast-paced learners seeking language review
NO open sections available for this course at the moment. Please check back next semester.


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Thursday March 06, 2014
Understanding the many faces and phases of addiction begins with a community conversation.
A young Vermonter wakes up and eagerly helps his family with daily farming duties. He's always had an open and supportive family and lived a fortunate life. Then, everything changed. His mother started noticing a difference in his behavior. He stopped attending family events--and when he did occasionally attend, it was never for long. She discovered farming equipment and tools had gone missing. Eventually, the story unfolds; her once innocent and healthy son was battling a strong addiction to prescription drugs.
This is just one of the many stories shared in the Kingdom County Productions documentary, The Hungry Heart. The documentary addresses the state's glaring opiate addiction problem by unveiling the recovering addicts' perspective. The Hungry Heart illustrates the raw and emotional story of one St. Albans pediatrician, his addicted patients, and his process of helping them on their road to recovery.
Introducing this film February 10 was the first component of a two-part PACT (Parents and Adults Celebrating Teens) event at SBHS to bring a more real sense of awareness to South Burlington residents and students and to provide an opportunity to talk about it. At the screening, director Bess O'Brien, Dr. Fred Holmes, and some of the recovering patients featured in the film were present for a moving and honest conversation. They truly brought the message home that addiction can happen to anyone. Another opportunity occurred at dialogue night on February 17, following a second screening of the film.
The ScreeningIn the film, Dr. Fred Holmes fosters genuine relationships with his addicted patients--young clients who were regular patients of his before he discovered their addiction. Dr. Holmes prescribes suboxone, a drug used to treat opiod addiction , but even more, Dr. Holmes provides them with a connection – one they can confide in without judgement.
Contrasted with stories of both adults and youth who share their experiences about battling addiction, The Hungry Heart highlights the journey that all addict's face, their darkest moments, successes, relapses, and their willpower to break the most difficult habit in their lives.
Since its St. Albans premiere in September, The Hungry Heart has touched viewers all across Vermont, and in other New England states, in community centers, town halls, theaters, medical centers, universities, and high schools. The South Burlington screening night's unique opportunity to meet the director, as well as Dr. Holmes and some of the recovering patients in the film, took the message to another level. Their personal perspectives provided an insightful and moving connection to the fragile lines that are crossed when addiction occurs following abuse of drugs prescribed to a patient for legitimate medical use for pain or following surgery, or with the illegal use of prescription drugs.
Dialogue Night
I am absolutely overwhelmed by that film," City Councilor Pat Nowak began. "It brought it home. It's our kids. It's not them. It's us."
The rest of the participants at the roundtable discussion nodded. The Hungry Heart made it personal, and as UVM social work professor and State Rep. Ann Pugh noted, the issue became less of something seen in Law & Order, and became more clearly a local public health and community issue.
Current treatment facilities are swamped. Wait-lists are long. Rather than seeing it as a closed door, the group voiced that treatment would need to come in the form of community support. This requires washing away the stigma of those riddled with the disease.
"The more we stigmatize those with addiction, the less likely they are to seek treatment," said Tracey Harrington.
Changing the stigma would require looking at the issue from a more inclusive perspective. As The Hungry Heart portrayed, susceptibility to prescription drug addiction does not discriminate: people of all ages, socioeconomic backgrounds, and family structures suffer from the disease.
"One of the things we know research-wise is that for kids, having an impactful adult in their lives makes a tremendous difference," Sally Tenney said. "The idea that every student and kid in the community has somebody, whether it's a peer or faculty member or community member--that we make sure everybody has somebody."
From the peer perspective, existing programs like the F.H. Tuttle Middle School's K2K (Kid to Kid) program and SBHS Peer Leadership program make room for this connection. Students could be trained on how to handle a situation in which a fellow peer comes for help, and the mentor can provide the available resources.
"One of the turning points for me in the legislature was when we heard about a situation where a young person opened his phone, dialed 911 and left it on the chest of a friend dying of an overdose and left because he was concerned that he would be found liable," said Rep. Helen Head. "We did try to address that by saying, 'No, you would not be.' You can call for a friend, you can call for help, and you yourself will not be liable."
Getting the people who need help most to come to these conversations is always difficult, said Mariah Larkin, PACTeen advisor. Approaches like The Hungry Heart screening, having parent support groups, introducing local resources like CenterPoint, or offering incentives like extra credit for students to attend these discussions may be a "one step at a time" tactic, but each step will be necessary.
Solving the issue will be far from simple, but having an entire community pitch in to help create healthy relationships could be the salvation of a suffering neighbor.
"Nothing is more fundamental than unconditional love," Michael Simoneau, a board member of the HowardCenter, said. He quoted Dr. Holmes: "We're not treating addiction; we are treating self-esteem."
"Dr. Holmes was always able to find something positive," Jason Cushner, coordinator of Neighborhood Learning Conversations and Rowland Fellow said. "The power of taking the positive position gives the message that we believe in them. Power of that belief said over and over again invites them to come back in and say, 'I'm having trouble believing in myself.' Little moments of belief go a long way."
SOURCE: Miranda Jonswold, Correspondent


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Use chart of body measurements to determinate your best fit.
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Hudson tuck lock attache. Black pebble leather with sterling silver monogram plate. Top handle, removable padded shoulder strap with 20" drop, large exterior pocket with collar button closure. Neoprene lined interior with nylon laptop sleeve, 3 pen and 2 device holders, leather key tab. 15.75" x 3" x 11" Made in the USA with imported pebble grain leather.
An exclusive design by Darby Scott.
This item has a customizable sterling silver monogram plate. The jeweler of your choice can engrave this or we can take care of it for you. Our engraving services take from 7-10 days. Fonts and option choices can be emailed to you upon request, or will be provided with a confirmed order.
Engraving services are complimentary.
Please note the return of any monogram bag that has been engraved will incur a restocking fee of $150.00.
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text: We will take you from the jungles to the farms in America. You will feel the whip of the overseer and the sweat of the slave. The cry for help and the discouragement of life. The hope and prayers for a better day has seemed to run from me. God where are you? I should have jumped from that big boat I would feel better dying as the salty water of the sea filled my lungs and I would never be abused again. We will teach you why you must wade in the water, and show you how to watch for the train.they are singing "when we gather at the river" after dark we will gather and pray then I will run, I will die, because I cannot take this another day. I will run or I will die. It makes no difference I am already dead. I have prayed, but my prayer has not heard, I have cried and I am told to be strong. I know there is a God up there, and He saw the anger and the hate of the master. The God of the heavens will let me see a better day. That day, will be with Him in glory.


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The National Republican Senatorial Committee's attack on Christmas
By Brian On December 17, 2007 · Leave a Comment
And you think liberals are mounting a War on Christmas? Watch this monstrosity… if you dare. It's bad enough to make you want to drown yourself in the eggnog bowl. After stopping the bleeding from your ears, first.
So, what's a bigger attack on Christmas? Desiring that government not meddle with it and allow people to observe how they wish, or appropriating a classic carol for partisan political purposes… badly Ick.


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Is the term perfect breasts valid?
Like our bodies, breasts come in all shapes and sizes and what constitutes the perfect breast is an individual choice. For any breast to be perfect, it must first have the capacity to perform the function that nature intended. In other words, it must be able to produce milk.
Image right; Salma Hayek's 36-C breasts helps make every movie she is in. Photo credit lazygirls
What each of us thinks of as perfect is totally subjective as we all have a different taste, but generally we look to what is aesthetically pleasing among the wide variety of sizes and shapes making a single answer unobtainable. We don't know if the ideal breasts are related to what's know as 'the divine proportion' of 1 to 1.618 as facial features have been related too, maybe someone needs to work on this.
The human growth element
As most of us suckled at the breast, it was a source of life, it gave us nourishment for which we are subconsciously grateful. We have a natural affection and even a sense of awe at the ability of the breasts to produce milk. These devices of lactation and comfort are world wonders which we either take for granted, or we are so confused at all the opinionated bullshit that dictates our view.
Sociology; Power and politics
But nowadays breast feeding is secondary to using our breasts to attract attention, enhance appearance and self-confidence regardless of our walk in life. Breasts as part of the human body have become politicised and many dressing like Halle would be prosecuted or persecuted in some countries.
Halley Berry
Halley Berry, celebrating her assets which no doubt you have seen in one of the over 40 movies she has appeared in like the James Bond Die Another Day and Cat Woman. You may have noticed in all her red carpet appearances, her breasts always play a key role and the photographers love her.
Image right; Halle Berry with an almost perfectly matched pair and not needing a bra.
Socially we know breasts are attractive, you must have noticed how especially men like to look, and you know that showing a little cleavage gets attention. Men's attention is a combination of biology, the deep subconscious choosing of a mate with the capacity to nature babies.
Secondly, it's not just guys who love a nice rack so they can indulge in physical gratification, women do as well. Thirdly, being seen with a well built woman lifts their ego a treat and in those early years of dating and perhaps marriage, displaying the right amount of cleavage and perhaps a promise ensures all those chores are completed.
We all know from our TV and movies that nice breasts, are great assets for any star, so lets consider a few:
Christina Hendricks
Christina Hendricks from the TV show Mad Men stuns audiences with her all natural 38-DDD boobs and a 5.8" stature keeping it all in proportion. This curvy role model has been praised as being an ideal shape for women and Christina has commented that the media are too focused on women's bodies and not their actual talents. But a 2010 study by the British Association of Aesthetic Plastic Surgeons attributed part of a 10% increase in the number of British women receiving breast augmentation surgery to her influence. The US Air core reportedly want to paint her in the nose of their planes as they have don with other famous models in the past.
Christina reportedly said that "I'm learning to celebrate what I was born with, even though it's sometimes been inconvenient. No doubt this is due to shopping and finding comfortable bras and then she has a heap of accusers insisting that they have to be fake and her slightly fuller figure is out of place in Hollywood. Christina's Advice to men.
All breasts are perfect, made as 'God' intended to suit our character and function.
The level of women's dissatisfaction with their breasts has given rise to breast enhancement to an entire industry.
Image right; a pleasing aesthetic, nice in size and proportion
Characteristics of perfect breasts
Both women and men enjoy seeing and looking at women's breasts, women mostly for the aesthetic, and men for both the the aesthetic and
commonly as a sexual fantasy.
In general breasts must be full, but not too large typically C or D cup along the lines of the classical model proportions of 36, 26, 36
Some prefer small, (men say a nice mouthful), while others like large breasts without sag to give a woman shape.
Breasts should project more forward than to the sides with the nipples pointing up a little.
Breasts should not be too hard and not too soft.
The slope of the breasts must be graceful and gentle although pointy nipples are considered a bonus.
The nipple and areola must be proportionate to the size of the breasts. Extremely large nipples on small breasts are considered unattractive. Smaller nipples on larger breasts is considered more acceptable, but does not qualify as perfection.
The colour of the breast, nipple and areola should be colour matched.
Perfect breasts count for squat if not inhabited by a pleasing personality.
Further reading
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Breasts in Perspective
Breast massage
Perfect breasts count for squat if not inhabited by a pleasing personality.
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Soba noodles have been an ingredient I've been wanting to try for some time now. They are made with buckwheat which lends a wonderful nutty flavour. This is a perfect recipe for a make ahead lunch, just keep the dressing separate until ready to eat.
Let's talk about the dressing for a moment. It is soy based with the addition of sesame, which is one of my favourite flavours. Sesame oil is wonderful; it is full of flavour and you only need a small amount. It gives this dish a wonderful nutty undertone, perfect with the soba noodles.
To garnish you can choose what you like but I love the creaminess of the avocado and fresh crunch of cucumber. I always encourage you to play with your food so hopefully this recipe inspires you. If you like things a bit spicy add a teaspoon or so of chili paste or another hot sauce.
Soba Noodle Bowl
Soba noodles
Uncooked shrimp, 1 portion
Swiss chard, de-stemmed and chopped
1 Egg, soft boiled
Cucumber, to garnish
Scallion, to garnish
Avocado, to garnish
Sauce Ingredients
3 tbsp Soy sauce
2 tsp Sesame oil
1 tbsp Rice wine vinegar
1 tsp Sesame seeds
1/2 tsp Chili flakes
Cook soba noodles according to package directions. Be careful not to over cook the noodles, they should only take 3-4 minutes. Drain and rinse with cold water. Set noodles aside.
Prepare sauce by mixing together all ingredients. Clean and peel the shrimp. Toss the shrimp with a tbsp of sauce and saute until cooked through. Remove from pan and set aside. Working in the same pan saute swiss chard with a tsp of oil, cook until wilted.
When ready to plate mix together soba noodles, swiss chard and remaining sauce. Top with cucumber, scallion, avocado and a soft boiled egg.


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|Follow @Luchito_mexico
Chicken Fajitas Recipe
Tex Mex is all about simple, delicious, spicy flavour and nothing encapsulates this wildly popular style than chicken fajitas. Do them well and you'll be rewarded with succulent & juicy chicken with bags of amazing flavour. Here's our version using our own Mexican Magic.
Checkout more Gran Luchito Chicken Recipes.
Slice chicken breast into thin strips
Mix together Gran Luchito Smoked Chilli Paste with lime, coriander, olive oil, dried coriander, salt & pepper.
Mix chicken with marinade and leave for a few hours
Chop red & yellow peppers and shallots
Griddle vegetables until charred
Griddle chicken until blackened
Bring together on a tortilla wrap and top with guacamole
Gran Luchito Smoked Chilli Chicken Fajitas
Chicken Fajitas Recipe
- 2 Cage Free chicken breasts
- 1½ Lime
- Handful fresh cilantro
- 1tsp Gran Luchito Smoked Chilli Paste
- Olive oil
- 1 Red onion
- 4 Wheat flour tortillas
- Dried oregano
- 2 Peppers (1 red & 1 yellow works nicely)
- 1 Avocado
- ½ Lime
- Roughly chopped cilantro
- Salt & pepper
- In a large bowl, squeeze the juice of 1 lime (add the zest if feeling extra fruity) , a lug of olive oil, Gran Luchito Smoked Chilli Paste, roughly chopped cilantro, a sprinkle of dried oregano and a pinch of salt & pepper. Mix well.
- Slice the chicken breast into strips and add to the marinade. Leave for as long as possible, but at least an hour or so.
- Meanwhile, slice the peppers and red onion into thin strips. In a mixing bowl, mix a good lug of olive oil with a good pinch of salt & pepper and then toss the vegetables in it.
- Once good to go with the chicken, heat a griddle skillet until very hot. Add the veg and allow to char on one side before flipping over.
- Make sure the griddle pan is reasonably clean before doing the same with the chicken. Take care not to overcook this as chicken breast is easy to do so. A good idea is to remove the strips before they are fully cooked and then wrap in foil to finish cooking.
- Combine the chicken and vegetables to serve.
- You can also heat the tortilla wraps in the the warm griddle skillet.
- Make a quick guacamole by mashing an avocado with some roughly chopped coriander, a squeeze of lime juice and a little salt & pepper.
- Serve everything on a platter with a few lime wedges and dig in.
Discover some other of our tasty tex mex ideas
Have you tried this chicken fajita recipe? If so please let us know how you got on.


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Welcome to St. Paul's Episcopal Church. The linked pages will give you details about our mission, history, leadership and the fullness of our Episcopal tradition. Be in touch with us if you have any questions. You can reach Rev. John Atkins at email@example.com
In addition, the church houses several programs that are significant in the local community, including a Christian-based pre-school program.
Grace Learning Academy's heartfelt goal is to have children learning to love to learn in an encouraging Christian environment. The staff provides a warm, nurturing and culturally diverse experience, supporting each child as an individual and helping them to reach their full potential. For more information on the Pre-school program, contact the Director, Beth Schott: email@example.com
We host a Spanish Immersion Program! Classes are available for Pre-school aged children up through adults. Check it out: oakwoodspanish.wordpress.com or contact the Program Director, Rochio Ruiz: email@example.com
St. Paul's is the Chartering Organization for Boy Scout Troop 101 and Cub Scout Pack 101. These are long-term relationships; both groups have had St. Paul's as their home for more than 50 years. Girls Scouts also call St. Paul's home and all three groups have regular meetings in our Parish Hall. Scout Hall is an area of the property given over to exclusive use of the scouts and is utilized for den, patrol and troop meetings, parent committee meetings, and for storage of camping and other scouting gear. To learn more about our scouting programs, contact Joseph Schenk. email@example.com
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Jump Clinic
We're back in a big way: Connor and I are going in a two-day jump clinic this weekend! I am going to EXPLODE with excitement! I'm sure the nerves will set in at some point over taking my little green bean into a clinic with the most accomplished trainer I've ever ridden with, but I'm too excited to be nervous right now! Way, way, way too excited!
Man, it's going to be exceptionally hard to sleep tonight. My brain feels like it's filled with exclamation points.
|Let's do this.


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How Dynamics GP Users Mine Microsoft, Other Users, for Guidance
When YRC Logistics was considering adopting Microsoft Dynamics GP, it wanted to make sure this was the correct solution, so officials asked Microsoft for feedback from existing customers of a similar size.
Microsoft was happy to oblige.
"We weren't sure it if it (the software) would work," said Tim Thorpe, manager, information systems for billion-dollar-plus YRC Logistics at the GP User Group Summit on Wednesday in St. Charles, Ill. "Microsoft really did a great job putting us in touch with some big companies that are doing some great things. If you haven't had a conversation about saying 'hey, I want to talk to other customers who are doing some big things,' I'd encourage you to do that."
One audience member, not yet on GP, said his company is growing and struggling with supply chain issues.


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As far as I know, I never laid eyes on him. No one ever will again either.
I believe Don joined me for my junior year. Looking at his yearbook picture jogs no memory for me whatsoever. I only remember his name for one reason.
He killed himself.
In the summer of 1988, Don was apperently on top of the roof of Evans' Department Store. From what I heard, he took a running leap onto Washington Street, and allegedly landed closer to the other side of the street. That's a hell of a jump. Needless to say, he was killed instantly.
Who he was or what problems he had I'll never know. My friend Dave commented that he had no idea who he was either. But as he thought about it some more, he then remembered that he'd had Don in homeroom. But he'd never had any contact with him.
During our senior year, Valori Franco (who I assume was friends with Don) put the name "Stumeier" on her senior sweatshirt as a tribute to him. Rest in peace Don.
UPDATE - 4/6/06 - Don's date of death was June 14, 1988. His location of death was the 1800 block of Washington Street - which I presume coincides with Evans' address. His remains were taken to the Malcor Funeral Home in Green Bay. He was buried in a very small cemetery in Depere. The name of the place is Greenwood Cemetery. The name of his gravedigger was Dave Calloway. Next time I'm in the area, I'll look up his tombstone, and get a picture of it. Is that ghoulish?


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Our goal is to promote individual responsibility and community commitment, while working together in a spirit that resolves problems, reduces crime and the fear of crime, and provides a safe environment for everyone. Our objective is to maintain and facilitate a positive relationship between the police department and the citizens we serve. In order for you to put a face with the name, please view the following link to our division:Link Here
In an effort to educate citizens, we have created a Residential Burglary Prevention Checklist which is attached and can also be found at the following link:Link Here
This checklist was designed to help residents examine their home and insure they are protecting against the common areas of weakness in residential security. To protect you and your family, please take a critical look at your home security every three to four months. Make this a priority and remember that crime prevention is a continuous process. Please share this checklist with your friends and neighbors and ALWAYS be aware of your surroundings. If you see something suspicious, please call the police.
The Frisco Neighborhood Watch is a crime prevention program that teaches citizens techniques to reduce the risk of being victimized at home and in public. It will also train citizens on the importance of recognizing suspicious activities, how to report them, how to make their homes more secure and properly identify their property. It also allows neighbors to get to know each other and their routines so that any out of place activity can be reported and investigated. This program will create a cohesive body of concerned citizens addressing issues that concern the entire community. The 2015 Neighborhood Watch Handbook is attached.
To become a Frisco Neighborhood Watch Block Captain, please apply here: Click on the Link Here
- Twitter: https://twitter.com/FriscoPD
- Facebook:
- •Instagam: @FriscoPD
- •Youtube: https://www.youtube.com/channel/UChBr2_T9wsZ6_-bxLj_Iyxw
- •Nextdoor: www.nextdoor.com